AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. July 2001, Volume 3, Number 7.


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Through the Patient's Eyes: New Doctor

A patient expresses his frustration about the frequent changes in his primary care physicians due to changes in his insurance coverage.

F.R. Burdette

New insurance. Another HMO—second in my first year of Medicare. I can't remember how many primary care physicians I've had since they started calling them that.

I arrive 20 minutes early for the first appointment with the new PCP, aware there is a woman waiting to thrust a clipboard and forms at me. Where do they find all of them—the forms and the women? I am still writing and making check marks 10 minutes after my appointment time. How many different ways are there to probe for employment, a working spouse—potential additional insurance coverage?

Age? Date of birth? Why both? She's already made copies of my driver's license and insurance card. Normal weight? 200. Weight gain/loss in past year? Plus 10 pounds. Height? At my best, I was 6 foot 3/4 inches; now I barely measure five eleven and a half. I hate to admit I'm not 6 foot anymore so I write "6'0." Maybe they won't catch it.

Married? Single? Widowed? Divorced? What's the difference between divorced and single? What is the need to know? Do single organs fail or function differently from divorced (or widowed or married) organs? Will it mean I'm strange if I say "single"? Or a failure if I check "divorced"? I feel single. I've been divorced twice, but I've been single three times—in all, a couple more years than I was married. I like feeling "single." I check that. The relationship of my emergency contact is "son" but I'm single. Does that matter anymore?

There are the standard questions about medications, allergies, illnesses, and surgeries. Here's one I haven't seen before: Sexually active? Not very. Sex of partners? Clearly they mean partner's sex. Wonder what the grace period is? I check "not sexually active"—reluctantly. It's not like I've given up hope. Sex of partners: "N/A."

Then the biggie. I like the way the Blood Bank asks it: Have you had sex with a male, or someone who's had sex with a male who has sex with other males, since 1976? (Something like that anyhow.) I'm always tempted to ask which month.

The rest aren't quite so invasive. Yes, I have noticed a loss of vision and hearing—seems like memory too. Yes, I have ringing in my ears, insomnia, and I snore. I also have shortness of breath, pains in my calves—and other assorted pains they don't ask about. There are a lot of things I don't like to admit even to myself but I keep checking them off. I really thought I was pretty healthy when I came in. I remind myself I'm not sick; I'm just here for an initial visit, referrals to my dermatologist and ophthalmologist, a new thyroid prescription, and a flu shot.

The good news is I stopped smoking and drinking and I have a regular exercise program. They ask about my Living Will and Durable Power of Attorney for Healthcare. I've brought copies of those and my organ and whole body donation and Do-Not-Resuscitate Order. Now the wait.

Over an hour past the appointed time, I am weighed in—214.80 with clothes. They don't check my height; I get by with that. They lead to me an exam room where the doctor joins me shortly. From the table, I look down at the top of his head as he reviews the list I brought along of things I thought were pertinent; his remarks are limited almost entirely to "fines," "very goods," and "excellents." I scrutinize him more thoroughly than he scrutinizes me. He's very bald but his red facial hair is thick and dark. He must be young enough that he will still be around when I need him, but that doesn't seem important in this day of revolving doctors.

He doesn't take my blood pressure or listen to my heart. He doesn't examine me—or look at me closely. The snap of latex gloves is conspicuous by its absence. Even my prostate feels slighted. He hasn't touched me except to shake my hand. No eye contact either.

He doesn't look at the forms I filled out. What are they going to do with those? Was it only that woman who was curious? In less than 10 minutes I have the referrals and prescription and am headed to the lab for a thyroid check on my way out.

The phlebotomist tells me I made a good choice of doctors. Maybe. Maybe this is patient-directed medicine. Maybe I'll like him if I get to know him. Maybe I should have brought a form for him to fill out. The jury is still out. I mean how can I tell? Actually I chose him for the proximity of his zip code. And he did originate the referrals and give me the prescription I asked for. That's all I really needed today—that and the flu shot I forgot to ask about and he didn't mention either.

F.R. Burdett walks the seawall and writes in Galveston, an island off Texas, in the Gulf of Mexico. His PCP is located 30 miles inland.

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